Quality improvement related to better antibiotics for skin infections in children
A quality improvement (QI) program implemented in a child health care system in Georgia was associated with improved antibiotic choice and duration for children with skin infections, researchers reported today in paediatrics.
The QI program, implemented in three emergency departments (EDs) and eight emergency centers (UCs) within Children’s Healthcare of Atlanta, aimed to optimize the selection and duration of outpatient antibiotics for uncomplicated skin/soft tissue infections (SSTIs). Optimal treatment was defined as 5 days cephalexin for nonsuppurative (no pus containing) SSTIs and 7 days clindamycin or trimethoprim/sulfamethoxazole for suppurative SSTIs.
Interventions included revised SSTI treatment guidelines, provider training, a discharge order set, and participation in a QI maintaining certification (MOC) project that included training sessions, monthly group feedback, and individual scorecards. The MOC QI project included 50 ED and UC doctors (27% of eligible doctors).
To assess the success of the program, researchers compared antibiotic prescribing dates for SSTIs during the baseline period (January 2018 to June 2019) and the postintervention period (July 2019 to March 2021).
A total of 9,306 SSTIs were included, with 5,507 ED visits (59.2%) and 3,799 UC visits (40.8%). Across all providers (MOC and non-MOC participants), optimal antibiotic choice plus duration for purulent SSTIs increased from 28% at baseline to 64%. For non-suppurative SSTIs, optimal antibiotic choice plus duration increased from 2% to 43%.
MOC participants had similar baseline performance but demonstrated greater improvement in optimal antibiotic prescribing for suppurative (84%) and non-suppurative SSTIs (68%). Return visits, which required an escalation of care, did not significantly change the situation before and after the intervention.
The study authors suggest that the greater improvement among MOC participants may have been driven by monthly individual performance scorecards.
“Although other QI projects have focused on inpatient treatment of SSTIs, this multisetting QI project focused on evidence-based outpatient antibiotic prescribing for pediatric SSTIs,” the study authors wrote. “Our findings could easily be generalized to other large child tertiary care centers looking to implement QI initiatives around outpatient antibiotic stewardship.”
September 8th paediatrics abstract
multiresistant Shigella Outbreak in Spain linked to cases in Belgium, UK
A study published this week in JAC-Antimicrobial Resistance confirmed that a multidrug resistant strain (MDR) Shigella sonnei in men who have sex with men (MSM) in Spain is similar to strains found elsewhere in Europe.
In the study, researchers from Seville, Spain, performed genomic and molecular analyzes of isolates from seven patients with shigellosis caused by MDR S Sonnei that shared similar epidemiological characteristics. The cases were reported at a university hospital in Seville from October to December 2021, and of the six patients who reported a sexual history, four were identified as MSM.
All isolates demonstrated resistance to penicillins, cephalosporins, fluoroquinolones, cotrimoxazole, and azithromycin, and whole genome sequencing identified multiple resistance determinants, including azithromycin resistance genes and the blahCTX-M-27 gene carrying an extended spectrum beta-lactamase (ESBL) enzyme.
Further analysis revealed that all isolates belonged to the same outbreak strain and were closely related to isolates from recent Extensive Drug Resistant (XDR) outbreaks. S Sonnei in MSM in Belgium and the UK.
“Our results indicate that we are dealing with a high-risk clone of S. sonnei in continuous evolution,” the study authors wrote. “The differences in terms of plasmid structures as well as the number of plasmids harbored by the seven S. sonnei Isolate seems to indicate that this outbreak was caused by transmission of a clone that can develop and spread rapidly.”
A report by the European Center for Disease Prevention and Control found an increase in XDR in February S Sonnei infections in the UK and elsewhere in Europe and warned that the risk of spread among networks of MSM engaging in risky sexual practices such as oral-anal contact could be high in the coming months.
The authors say they are tracking the spread of successful epidemic clones of MDR S Sonnei and understanding their evolution will be important for monitoring and controlling outbreaks.
5th September JAC Antimicrob Resist to learn
#Stewardship #Resistance #Scan
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